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Topic starter
Hello,
Currently we have been using PACS solution for processing radiology orders in our ambulatory clinic. I would like to know what is the workflow that is followed for placing the Future orders in EMR.
any input would be greatly appreciated.
Posted : July 28, 2016 5:46 am
This is a significant topic and the optimum workflow will depend somewhat on your PACS and how orders have been set up in Centricity, but in a nutshell, here is the process we would use:
- Have ordering physician use the GE orders module and make sure the disposition status is set to "Admin Hold" on the order for all future orders. This prevents order from crossing over to the billing module (that happens when the order status is marked "complete") and also keeps any HL7 traffic from communicating with your PACS/RIS (if you have an orders interface between EMR and PACS/RIS).
- When patient presents, physician or radiologist releases the RAD order by setting its status to "In Process." Once the results have been completed and interpreted by the radiologist, have them attach a reference link (could be http link or link to an image file depending on your PACS; typically it is a URL) to the encounter document. The encounter template would likely contain a custom form that would allow the physician to directly link to the results in the PACS and allow them to document their impression.
- Once all the documentation was captured, someone would need to mark the status of the radiology order to "Complete" so that it would transfer to the billing system.
The order types GE has built into their system (i.e. Services, Tests and Procedures, and Referrals) often limits what you can do without using third party interface engines. We utilize Qvera to handle the bulk of our communications between systems because it gives us visibility into the traffic and allows us to incorporate additional business logic that cannot be achieved with their current orders module.
As I said, there is a lot of work in vetting out order workflows but this is the general idea for future orders. GE could make things a lot easier on folks if they had a way to programmatically change the status of an order with MEL code. I have participated in their CPOE workgroup and they are very aware of the limitations in their current orders module. This is one of the reasons they chose to focus on it first for their Northstar initiative.
Posted : July 28, 2016 11:24 am
Topic starter
Thank you much for your recommendation. Since it is a future order what date that is being specified in the start date field?
The current workflow that is being followed is that, the future orders are performed usually at the next appt date for the patient and this information would not be available until the pt makes an apt at the front desk. So, the orders are not being placed at the time of the visit. There is only an verbal in the chart and once the apt is made the MA would do a chart review and hand the schedule to the rad tech. That's when the orders are put in to the system and are held in a proxy folder until the patient presents.
Posted : July 28, 2016 12:52 pm
Neetha,
the order date or start date would typically coincide with the appointment date once it is known. You can enter an approximate date if the provider wants the future order performed within a relative timeframe (e.g. 6 months from current date) at the time they decide they want the RAD study performed and then modify the start date once the appointment date is known. You can also add clinical comments to the order itself to identify the appointment the order should be associated with. One of the features I have stressed to GE is that clinics need the ability to associate a future order to an appointment in the system. Patients, providers, and billers often need a view of all of the services/orders that were performed at a particular visit and the current design doesn't allow for this in an intuitive way. Billers also want to be able to associate the charges with the date of service and this can be particularly problematic with future orders. I have also found it is very difficult to train and govern the end users when dealing with future orders. Too bad you don't live closer to Tennessee; we would be happy for you to visit our clinic and see how we handle the different workflows. As an endocrinology specialty, most of our orders are future orders for labs or RAD procedures so we are very familiar with the challenges.
Posted : July 28, 2016 4:57 pm
Topic starter
Thank you much for your response. Your suggestion was my thought process to change the current workflow so the orders are placed during the visit encounter and separate encounters are not initiated just to place the orders. I would like to talk to you further about this. Is there anyway we could accomplish this?
Posted : July 29, 2016 4:25 am
We switched to a new RIS/PACS in January and our new workflow works as follows:
Order is placed with the startdate being the date the exam should be performed. (sometimes a year+ out) and the order automatically gets placed into an In Process status. This triggers LL to send a message to our Qvera engine which then modifies it quite a bit (splits multiple orders into separate files and does some mapping) and sends it into our RIS into a section it has called Pre-Orders. The radiology scheduling department works the preorders sorted on the order date which could be in the future. They stay pre-orders in RIS until they are scheduled by radiology in a date/timeslot.
Orders get closed out when the results get sent back to EMR. (most of the time)
Posted : July 29, 2016 5:13 am
You may email me directly (my email is accessible when you view my profile) and we can try and set up a time around a lunch hour. I would like to have our head nurse involved in the conversation as well. We work closely together on our clinical workflows and I think her insight would be good to have from a clinical perspective.
Posted : July 29, 2016 6:06 am
